Subfascial Breast Augmentation Research Articles

A comparison of textured vs smooth surfaced implants in sub fascial breast augmentation.

Subfascial placement of breast implants has the advantages of subglandular and submuscular placement without the adverse outcomes. This study examined the differences in outcomes between textured and smooth implants. A total of 385 patients underwent subfascial breast augmentation in two cohorts. The initial series (n=209) employed textured implants and the second (n=176) employed smooth implants. In all other respects, patient management was identical. Adverse outcomes, changes in breast morphometry, and patient satisfaction were compared between the two groups. The follow-up period ranged from to 74-272 weeks for smooth implants (mean 164 weeks, STD 50.6) and 78-279 weeks for textured implants (mean= 186 weeks, STD=54). The incidence of capsular contracture was the same for smooth and textured implants (4.7% and 6.2%, P=.64). Changes in breast shape at the lower pole, patient satisfaction, and the incidence of other adverse outcomes were the same in both groups. Subfascial placement of smooth and textured breast implants yielded similar outcomes.

Chest Feminization in Transwomen with Subfascial Breast Augmentation-Our Technique and Results.

The increasing population of this minority community is approaching plastic surgeons more frequently to achieve their dream of becoming a phenotypic female, the breast being the single sure identity. After undergoing the bottom surgery (SRS) which is essential for them to gain entry into the transgender community, very few take up hormone therapy; the rest approach plastic surgeons for chest feminization which includes breast augmentation. A total of 177 transgenders underwent subfascial breast augmentation between 2014 and 2023. They were followed up for 10years. Their demographics were documented. Operative details and postoperative complications were analyzed. Patient-related outcome measures were performed for size, appearance and cleavage. A well-performed surgery in our cohort had a good aesthetic outcome even after many years. Only three patients were dissatisfied with the size; revision surgeries of 12 patients done elsewhere had many complications like wound dehiscence and exposure, scar hypertrophy, low placed axillary scars, capsular contracture, asymmetry, and nonspecific pain. All of them had submuscular placement. The subfascial placement of implants in transwomen had good aesthetic outcomes with fewer complications and good acceptance. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An Analysis of Ptosis following Subfascial Breast Augmentation: Calculations That Explain Dogma.

Implant placement can improve ptosis due to the position of the nipple, inframammary crease, and base of the breast acting together. The interrelationship between these was quantified via changes in morphometry following subfascial augmentation, and explains the circumstances under which dogma holds true. One hundred seventy-five patients underwent a series of static measurements before and 3 months after subfascial breast augmentation. Ptosis in the nipple and base of the breast was calculated before and after surgery. All measurements except that of the the lateral sternal margin increased after surgery. All grades of ptosis reduced following surgery. There was lowering of the base in grade 1 patients, but not for other grades. Increased base ptosis correlated with reduced lateral sternal margin (1.9 cm compared with 2.9 cm; left, H5 = 24.7, p < 0.01; right, H5 = 24.5, p < 0.01). Implant volume did not correlate with change in ptosis at the nipple or base. Reduced ptosis was associated with implants that are a narrow match of implant to breast (0.52 to 0.95) (left, H5 = 28.3, p < 0.01; right, H5 = 24.9, p < 0.01). Decreasing ptosis correlated with lower lateral sternal margin compared to breasts that increased ptosis. Change in ptosis following surgery does not correlate with having children. Subfascial placement has varying effects on ptosis. Non-ptotic or mildly ptotic breasts appear to improve due to a disproportionate descent of the inframammary crease relative to the nipple and base. Patients with little breast tissue are more susceptible to an increase in "bottoming out," particularly if broad implants are used. A ratio matching implant to the base width has predictive value on outcome. Therapeutic, IV.

Subfascial versus Subglandular Breast Augmentation: A Randomized Prospective Evaluation Considering a 5-Year Follow-Up.

Subfascial breast augmentation is becoming popular because of a better understanding of breast anatomy. However, because the subglandular approach is also another popular method, it is critical to assess the influence of the superficial fascia of the pectoralis major muscle on the subfascial and subglandular pockets to determine if one method is superior to another. This study investigated whether there are clinical/radiological differences between subfascial and subglandular pockets following primary breast augmentation. Twenty patients were recruited, and each was randomly sorted to the subfascial and/or subglandular pocket per breast. Both patients and surgeons were blinded. Differences were evaluated through five independent surgeons and by magnetic resonance imaging scans. Subsequently, 1-year and 5-year follow-ups were conducted. The results of the 5-year follow-up considering the aesthetics of the breast contour were significantly different between groups, with more good and excellent evaluations in the subfascial group. Regarding breast shape, there were also statistical differences, also with more good and excellent evaluations in the subfascial group. For breast consistency, subglandular had 84.20 percent of patients classified into Baker I and II, whereas subfascial had 100 percent. Magnetic resonance imaging scans showed a smaller implant base in the subglandular pockets, which was a significant result. There were no significant differences in implant projection. Comparison of the number of folds revealed significant differences between groups, with more folds in the subglandular group. Statistical differences between methods were found regarding breast shape and contour, capsular contracture, implant base, and the number of folds, showing that subfascial breast augmentation is superior to subglandular breast augmentation. Therapeutic, II.

Observations Concerning the Match between Breast Implant Dimensions, Breast Morphometry, and a Patient-reported Outcome.

Background:Outcome studies in breast augmentation do not assess how an implant has been matched to the soft tissue envelope. The study hypothesis is that there is a relationship between breast and implant dimensions and the subjective outcome of patient satisfaction.Methods:In a study of patients undergoing subfascial breast augmentation (n = 341), morphometric measurements and a postsurgical survey of satisfaction with breast size were performed 3 months postoperatively. A ratio empirically derived from breast width, implant width, and projection (Rib) was calculated in patients who wished to have smaller, bigger, or no change in their implant size.Results:76% were content with breast size, 16.7% wished to be larger, and 7.3% wished to be smaller. Rib differed between groups who did not want to change size (n = 259, mean = 5.8, SD = 0.9), those who wished to be bigger (n = 57, mean = 5.6, SD = 1.1), and those who wished to be smaller (n = 25, mean = 5.3, SD = 1.3, H(341) = 14.0, P < 0.01). Rib differed between groups whose result was as expected (mean = 5.6, SD = 0.9), compared with those who expected to be bigger (mean = 5.4, SD = 1.2) or who expected a smaller outcome (mean = 5.6 SD = 1.0, H(341) = 18.3, P < 0.01).Conclusions:These data provide an objective measurement by which studies concerning breast augmentation can be reported and compared. The method may guide standardization of clinical research regarding breast implant surgery.

Subfascial Breast Augmentation with Crossed Fascial Sling, Under Tumescent Anaesthesia With or Without Sedation and Lower Periareolar Access.

The tumescent technique is very effective for subfascial breast implant surgery. A total amount volume of 330cc (120/160cc for each breast) ensures a clean and bloodless field, leading to less postoperative bruising and prolonged local anaesthesia effects. The surgical procedure can be performed with or without associated sedation. Lower periareolar anaesthesia allows for good and painless infiltration of the surgical field, up to the prepectoralis plane. A smooth, vertical dissection reached the pectoralis fascia, which was smoothly opened, leaving the gland adhesions in place. Subfascial pocket dissection was performed, and the implant was then inserted. The fascial sling, consisting of 2 strips of approximately 4/5cm × 2cm each, was prepared superiorly and crossed for inferior fixation. One hundred patients were included over 18months, and all surgeries were performed under tumescent anaesthesia with general sedation. Overall, we did not need to convert from local anaesthesia in general. No complications were observed, and good cosmetic results were achieved. The follow-up periods lasted for 6months or, in a few cases, for 1year.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Subfascial Breast Augmentation: A Systematic Review and Meta-Analysis of Capsular Contracture.

BackgroundSubfascial breast augmentation is a technique originally developed to reduce the risks of capsular contracture while decreasing the postoperative pain associated with subpectoral augmentation. It was pioneered in Brazil by Dr. Graf and others, and recently this technique has gained interest in the aesthetic world.ObjectivesThe goal of this study was to provide a systematic analysis of subfascial breast augmentation to assess the combined reported rates of capsular contracture, animation deformity and complications.MethodsThe PubMed, Embase, and Web of Science databases were searched for the use of the subfascial plane for breast augmentation. We included studies that reported on capsular contracture and other outcomes following subfascial breast augmentation.ResultsThrough the initial search, 26 articles were identified. Of which, 22 were included in the final study. A total of 3743 patients were identified across these studies with a total number of 38 cases of capsular contracture representing a rate of 1.01% of capsular contracture. Several articles reported on demographics, perioperative and long-term complications, and outcomes with regards to the aesthetic outcome from the surgeon’s perspective. Several infections were reported representing a rate of 0.1%. Animation deformity was not reported, although rippling was occasionally reported as was malrotation, axillary banding, sensory deficit, and asymmetry. Subfascial breast augmentation appears to have a low complication rate and an extremely low rate of capsular contracture at approximately 1%.ConclusionsSubfascial breast augmentation may provide the benefits of low rates of capsular contracture while avoiding the discomfort and future animation deformity of subpectoral augmentation.Level of Evidence: 4

Quantitative Appraisal Through MRI of Breast Tissue Thickness and Implant Projection After Breast Augmentation with High- and Extra-High-Profile Round Implants.

Changes in breast tissue thickness and in implant projection 5years after augmentation with high- and extra-high-profile round implants were measured through MRI with a DICOM standard viewer. Twenty-four females with small-volume breast asymmetry without hypertrophy or ptosis underwent subfascial breast augmentation for cosmetic purposes, by using micro-textured soft cohesive silicone gel-filled round implants, from a single manufacturer. MRI measured the linear antero-posterior dimension of breast tissue thickness and projection of the implants. Statistical analysis of data was performed by Pearson correlation coefficient, line graph, and scatter diagram. The "r" of Pearson for right and left breasts indicated a significant correlation between the breast tissue thickness before and 5years after augmentation. Closeness of the lines displayed in the line graph indicated strong linear positive correlation between the breast tissue thicknesses. The "r" values for projection of right and left implants indicated a significant correlation between the projection standardized by the manufacturer and that encountered 5years after augmentation with high- and extra-high-profile round implants. A scatter diagram of data indicated a strong positive correlation between implant projection standardized by the manufacturer and that encountered 5 years after augmentation, on both breasts. Soft cohesive silicone gel-filled high- and extra-high-profile round implants supported breast tissue compressing without significant loss of the implant projection. Despite the consistency of the soft cohesive silicone gel, the implant softness and flexibility were preserved, resulting in low-pressure gradient over the mammary parenchyma without significant changes of the breast tissue thickness. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The New Method of Pocket Forming for Breast Implant Placement in Augmentation Mammaplasty: Dual Plane Subfascial.

Introduction:Breast augmentation is one of the most frequently performed aesthetic surgical procedures in the world. The most important preoperative decisions which influence the final appearance of the augmented breast are the breast implant pocket choice and selection of the most appropriate implant. Described pocket locations are subglandular, subfascial, partially retropectoral, totally submuscular and dual plane.Aim:We have introduced a new method of pocket forming for implant placement, which is combination of Tebbett’s dual-plane 2 or 3 and Graf’s subfascial. We named it as dual plane subfascial.Methods:Between January 2016 and April 2018, total of 27 patients were operated using dual plane subfascial breast augmentation. The pinch test in the medial pole less than 2,0 cm and in upper pole less than 2,5 cm are indications for this technique. In our modification, in primary cases a dissected flap in front of muscle is fasciocutaneous (not cutaneous as in Tebbett’s technique). It will be finally located caudally of pectoral muscle and in front of the lower pole of implant. Fasciocutaneous flap in primary cases and two independent levels of soft tissue coverage (fascial and cutaneous) in secondary cases (subglandular to dual plane subfascial conversion) in front of the lower pole of implants provide better coverage than cutaneous flap alone.Results:Hematoma and infection did not occur in any patient in our study. A capsular contracture grade I/II without the need for reoperation occurred in two patients. In one patient with secondary augmentation minimal bottoming out was noticed (before reoperation patient had significant bottoming out deformity). Minimal palpability of implants is recorded in three patients.Conclusion:Dual plane subfascial is a good option in primary breast augmentation with a well set indication especially in the breasts with the upper pinch test less than 25 mm and medial pinch test less than 20 mm. The idea can be followed even in secondary breast augmentation (subglandular to dual plane subfascial conversion). There is additional soft tissue in front of the implant which led to a less implant palpability, especially in thin patient with smaller amount of subcutaneous fat.

Breast Durometer (Mammometer): A Novel Device for Measuring Soft-Tissue Firmness and Its Application in Cosmetic Breast Surgery.

The measurement of soft-tissue firmness has many potential applications in medical practice. This study reports a user-friendly, novel device that is capable of measuring changes in soft-tissue firmness in a reproducible manner. The study reports the development of the equipment and how it has been applied to breast implant surgery. The device was tested for both intra- and inter-observer variability on an in vitro model, using a breast implant. Once reproducibility was confirmed, breast firmness was measured on a series of patients who underwent sub-fascial breast augmentation (n=50) to examine how it varied post-operatively. Firmness in the upper half of the breast increased to a maximum level two weeks post-surgery (0.44-0.61Pa), reducing to pre-operative levels by 6weeks (0.37-0.54Pa). There was no further significant change at 12weeks. Firmness in the nipple areolar complex (NAC) and at the lower outer quadrant (LOQ) followed a similar pattern, but remained firmer at 12weeks. We interpret these patterns as implying that measurements taken at the upper half of the breast are indicative of post-operative oedema, whereas those at the NAC and LOQ represent changes in firmness produced by the breast implant composite. We consider the potential for this novel device in the measurement of soft-tissue firmness in aesthetic breast surgery and would encourage other researchers to explore novel applications. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective Sensory Changes Following Subfascial Breast Augmentation

Sensory changes occur following breast augmentation, and describing the incidence, pattern, and course of deficit is important for informed consent. To examine sensory changes following subfascial breast augmentation, and the influence of change in breast volume caused by an implant. One hundred and sixty-two consecutive patients undergoing subfascial breast augmentation were assessed for sensory changes using a Semmes Weinstein monofilament test before surgery, 2, 6, and 12 weeks postoperatively. Morphometric measurements allowed a breast volume to be calculated and the percentage change in volume produced by the implant. Most women (92.5%) regained preoperative levels of sensation in all areas of the breast, excepting the lower-outer quadrants (16.15%) by 12 weeks following surgery. Four percent of nipple-areolar complexes (NAC) failed return to preoperative levels of sensitivity by 12 weeks after surgery. Younger patients or those who have a high BMI and a measurably thicker soft tissue envelope were more likely to experience sensory deficits. Breast augmentation in this series produced calculated volume changes by an implant of between 12.1% and 102.7%. Within these limits there is no association between percentage increase in breast volume and sensory deficits. The study demonstrates that for calculated volume increases of up to 102% of the initial breast volume, sensory loss at 12 weeks after surgery is 4% at the NAC. The commonest area of diminished sensitivity is the lower-outer quadrant (16.15%), relating to the use of the inframammary crease incision. It provides a useful adjunct in monitoring patient recovery following subfascial breast augmentation. LEVEL OF EVIDENCE 4: Therapeutic.

Aesthetic and Reconstructive Surgery of the Breast

Drs. Hall-Findlay and Evans' new Aesthetic and Reconstructive Surgery of the Breast is a unique work providing a purely surgical focus, covering the full scope of breast surgery. Coverage of hot topics includes new implant types, gel implants, fat injections to the breast for aesthetic enhancement, and fat injections for reconstruction. The book is organized into seven sections including reduction, mastopexy, augmentation, and more. Expert, international contributors deliver practical advice on the latest techniques, with a special emphasis on what can go wrong and how to avoid it. This full-color, templated reference comes with case studies and 16 video clips (both on web and on DVD) with approximately three hours of footage demonstrating key procedures. Video coverage includes form-stable high cohesive silicone gel implants, short scar with inferior pedicle, and sub-fascial breast augmentation. Expert Consult access enables you to search full text online and download images.

Endoscopically Assisted Aesthetic Augmentation of Tuberous Breasts and Fat Grafting to Correct the Double Bubble

Treatment of tuberous breasts types 1 and 2 must deal with the problem of the pseudo-double bubble in the primitive inframammary fold and also must release the constrictive ring. Two techniques currently are used to overcome these problems, but neither is entirely satisfactory. The first technique, in which the approach is via the primitive inframammary fold, leaves significant scarring when the lower poles expand. The second technique, in which the approach is periareolar, considerably reduces the area's sensitivity. This report presents a new endoscopically assisted technique with an axillary approach designed to solve these problems. Between 2005 and 2010, 68 patients (ages 18-42 years) underwent surgery. The intervention was bilateral in 57 and unilateral in 11 of these patients. All cases involved tuberous breasts types 1 and 2 (Grolleau's classification). The augmentation involves a transaxillary subfascial endoscopic approach, opening of the fascia at the primitive inframammary fold, and releasing of the constricting ring to enable the breast to expand, followed by implantation of an anatomic prosthesis to add volume to the lower quadrants. If the pseudo-double bubble appears, fat grafting is applied during the same surgical procedure. The results were reported to be highly satisfactory both by the patients and by the independent medical team. For six patients (8.82 %), fat grafting had to be repeated in the double bubble. No major complications were reported. The endoscopically assisted subfascial breast augmentation technique obtains highly satisfactory results in tuberous breasts types 1 and 2 (Grolleau's classification). The single scar is concealed in the axillary fold. This journal requires that authors assign a level of evidence to each article.

Capsular contracture in subfascial breast augmentation: recommendations and treatment

Capsular contracture is the most common long-term complication of breast augmentation. In subfascial breast augmentation, there had been reports of 0% to 2% of capsular contracture (Serra-Renom et al., Plast Reconstr Surg 116:640–645; Ventura and Marcello, Aesthetic Plast Surg 29:379–383; Tijerina et al., Aesthetic Plast Surg 34:16–22; Graf et al., Plast Reconstr Surg 111(2):904–908). Graf et al. mentioned a 2.3% of capsular contracture grade II in 263 patients that underwent subfascial breast augmentation (Graf et al., Plast Reconstr Surg 111(2):904–908). There are several theories that can explain the presence of a capsular contracture, and the most described are: the microbiology theory and the contamination of the pocket due to a foreign body (Araco et al., Plast Reconstr Surg 124(6): 1808–1819; Schaub et al., Plast Reconstr Surg 126(6): 2140–2149). In 5 years, 35 patients with breast augmentation were considered for surgical treatment for capsular contracture. From 35 patients, only 4 patients were operated by us initially, the remaining 31 came to us as new patients with a capsular contracture. Each patient had different characteristics and was classified with the Baker scale. Depending on the grade (I–IV) and clinical characteristics of the patient, the surgical treatment was selected between a subcapsular pocket, total capsulectomy with or without implant, or radiation of the capsule. Thirty-five patients were considered for surgical treatment for a capsular contracture. All of our patients had great outcome at short and long term without any signs of complications. Twenty-seven patients were followed for 2 years postop, and 8 patients treated with a subcapsular pocket have less than 2 years of follow-up. In patients with less mammary gland tissue, a subcapsular pocket had reduced the risk of complications of a total capsulectomy due to close relationship between the skin and the capsule. There are several complications that could be present with a total capsulectomy, which are: tissue necrosis, breast irregularities, and/or damage to the skin. This technique had produced great results in patients with lo mammary tissue and a capsular contracture. Capsular contracture is the most common long-term complication in breast augmentation. There are several techniques that can be reproduced to have better outcomes and reduce the risk of complications. We recommend the use of these strategies to help in the treatment of capsular contracture.

Subfascial Breast Augmentation: Is There Any Advantage Over the Submammary Plane?

Subfascial (SF) breast augmentation has been proposed as an alternative to placement of a breast prosthesis in a subpectoral (SP) or direct submammary (SM) plane, producing advantages over both techniques. This study compares complication rates in 200 SF-placed implants with 83 SM implants, undertaken over a 51-month period by a single surgeon. No statistical difference was found in the complication rate or patient satisfaction of one technique over the other. No clinical advantage can be demonstrated by placing breast prostheses behind the pectoral fascia compared to directly behind the breast.

Bilateral Transaxillary Subfascial Breast Augmentation with Smooth Saline Implants: A Retrospective Analysis of Short-Term Complications

Introduction: To determine, by means of a retrospective study, the short-term complication rate of primary, transaxillary, subfascial breast augmentation using smooth, high-profile, saline implants. Comments and comparisons on observations will be made. Materials and Methods: A retrospective, private practice, medical chart review of primary, transaxillary breast augmentation surgeries with smooth, high-profile, saline implants done from 2004 to 2008 was performed. A list of short-term complications was compiled. We reviewed 273 charts, and complications were assessed at 1 week, 1 month, 3 months, and 6 months. The patients' and surgeons' comments in the medical charts and full preoperative and postoperative photographic documentation were evaluated. Adverse events were noted. These included surgical wound infection, breast pocket infection, wound dehiscences, hematomas/seromas, clinically significant Baker grade III to IV capsular contractures (grade III to IV firm with visible/obvious spherical distortion), rippling, asymmetries, nipple/areola sensory losses or deficits, and reoperations. Results: The short-term complications for bilateral, transaxillary, subfascial breast augmentation with smooth saline implants in this private practice occurred in the following percentage of patients: breast asymmetry, 6.95%; reoperation, 4.76%; clinically significant Baker grade III to IV capsular contracture, 2.56%; wound dehiscence, 2.19%; rippling, 1.83%; hematoma/seroma, 1.83%; and wound infection, 1.09%. It should also be noted that bleeding from the incision site, galactorrhea, formation of a hypertrophic scar, breast ptosis, and a breast pocket infection rate occurred in less than 1% of the patients. Conclusions: Primary, transaxillary, subfascial breast augmentation with smooth saline implants is both safe and effective. It offers the advantage of fewer scarring problems, and it protects nipple/areola sensation. The patients in this study seemed to experience fewer complications from this procedure than patients in other studies, but more studies are needed.

Mondor’s Syndrome: A Clinical Finding on Subfascial Breast Augmentation

Mondor's syndrome is a clinical finding that can present in young to middle-age women 7-14 days after subfascial breast augmentation. Three cases of women who presented Mondor's syndrome after subfascial breast augmentation are reported. The cases were characterized by a tender and painful cord that originates on the middle clavicle line from the inframammary border to the umbilicus scar on the thoracoabdominal wall.

Subfascial Breast Augmentation: A Comprehensive Experience

Subfascial breast augmentation, first performed by Dr. Ruth Graf in 1998, places the implant above the pectoralis muscle but below the pectoralis fascia. Graf documented that this approach resulted in less capsular contracture than subglandular implant placement and a more natural shape while eliminating implant animation with arm movement. In addition, implant edge visibility was decreased compared with subglandular implantation in all but the extremely thin patient. Because of the described benefits and high patient satisfaction, the authors began to perform this technique in 2006. This report presents a comprehensive review of the aforementioned technique by describing a large series of subfascial augmentations (inframammary, periareolar, and endoscopic transaxillary) as primary procedures, secondary procedures, and operations with concurrent use of mastopexy performed by a single surgeon using multiple approaches. A patient satisfaction questionnaire was used in addition to a detailed clinical assessment. The results of this procedure were reproducible, controllable, and predictable. The study demonstrated a high degree of patient and surgeon satisfaction with few complications, a low rate of capsular contracture, no evidence of breast animation with arm movement, excellent lower pole coverage, and a brief recovery period. Subfascial breast augmentation is a safe, effective procedure allowing for predictable results with excellent shape and longevity. For the properly selected patient, this approach provides the benefits of subglandular and submuscular placement without the disadvantages associated with each.

Can the Pectoral Fascia Integrity Be Preserved During Subfascial Breast Augmentation Through the Axillary Approach?

Although many authors recently have reported good results with subfascial breast augmentation, it still is controversial whether the integrity of the pectoral fascia can be preserved. Some authors think the pectoral fascia will be broken during the operation because it is thin and weak. Therefore, this study aimed to investigate whether the integrity of the pectoral fascia can be preserved during subfascial breast augmentation through an axillary incision without endoscopic assistance. For this study, 10 patients underwent subfascial augmentation mammaplasty through the axillary approach. The technique was used for patients with small or moderate breasts. The pockets were made with the fingers. The area beyond the reach of the fingers was dissected using a breast dissector. Then the pocket and major pectoral fascias were examined with an endoscope. The endoscope was used only to inspect the fascia and major pectoral muscle after the subfascial dissection was completed. The fascia and surgical effects were evaluated. The integrity of 11 (55%) of 20 pectoral fascias in 10 patients was preserved during the surgery. Four fascias (20%) were broken at about the fourth intercostal space or at the fifth costa. In five breasts (25%), the superficial layer of the pectoral muscle was split, but the integrity of the fascia was maintained. All the patients except one with asymmetric breasts achieved satisfactory results. There was no active bleeding, hematoma, infection, or fibrous capsule contracture during the follow-up period. The integrity of most pectoral fascias (11 + 5 fascias) could be preserved through the axillary approach during subfascial breast augmentation without endoscopic assistance. Even if the lower portion of the pectoral fascia was broken, this did not interfere with the aesthetic outcome or the normal postoperative recovery.

Experience of 1000 Cases on Subfascial Breast Augmentation

Throughout the years the female breast has been manipulated through aesthetic and reconstructive surgery. Since the 18th century there have been reports of techniques that have tried to increase the volume of the mammary gland. This article demonstrates a technique for increasing the volume of the mammary gland by dissection of the fascia of the pectoralis major muscle. This technique provides long-term results due to the optimized dynamics between the soft tissue and the implant. The subfascial technique is paramount to the subglandular method because primarily it offers better palpable firmness in the periareolar area, a significant decrease in the step effect produced by an excessive projection of the breast, a favorable gravitational pull of the breast, and a considerable reduction in the incidence of capsular contractures. The movement of the implant, postsurgical pain, and bleeding caused by the incision of the pectoralis muscle diminish with this technique. Because of the fascia's tendency to be preserved, this procedure has the advantage of being able to be applied where previous surgery has been performed; this concedes the subfascial technique a more versatile angle. In the last 10 years 1000 patients were subjected to subfascial breast augmentation with soft-gel cohesive textured implants. An inframammary incision was used in 95% of the patients and the periareolar incision in 5%. The patient does not suffer from immediate postsurgical pain. Recovery time and the ability to start daily activities is briefer than after the submuscular procedure. A better projection is obtained without the need to use a bigger implant to get the same result because there is no pressure on top of the implant as in the submuscular technique. The subfascial procedure offers a high-grade result for the short and long term and has fewer disadvantages than the submuscular or subglandular technique. Likewise, there are fewer immediate postoperative symptoms and patients have a much better and less painful recovery. The morbidity in these patients is less than with the subglandular and submuscular methods.